Rapid Nutritional and Health Assessment of the Population
Affected by Drought-Associated Famine -- Chad

Chad, a landlocked country of approximately 4.5 million people,
was one of the countries most severely affected by sub-Saharan
Africa's recent drought and associated famine. The drought caused
many Chadians to leave their villages. Some voluntarily resettled
in
food-for-work settlements along dried-up river beds; others moved
to
makeshift encampments near towns and villages. Food aid and health
care for the majority of these displaced persons was limited. The
U.S. Agency for International Development (AID), with the
concurrence
of the Government of Chad, asked CDC to provide a team to conduct a
rapid assessment of the health and nutritional status of the
displaced
population. This assessment was performed in January 1985, with
the
cooperation of AID, the Chadian Ministry of Health, Medecins Sans
Frontieres (MSF), and other private voluntary agencies.

Seven sites were assessed in seven of the country's 14
prefectures. The sites included a variety of displaced-person
settlements, food-for-work programs, and unstructured population
concentrations around villages, but these sites were not randomly
chosen. At each site, the nutritional status of a random sample of
children 1-5 years of age was assessed by anthropometric methods.
Except at two sites, where weight-for-height surveys had been
conducted by MSF, the mid-upper arm circumference method was used.
Recent measles occurrence and measles vaccination coverage at each
site were determined, along with the estimated incidence of recent
diarrhea. Diarrhea treatment methods also were determined.
Respondents were asked about recent malaria or unexplained fever,
and
water availability and sanitation needs were assessed.

Levels of acute undernutrition (less than 80% of median
weight-for-height or mid-upper arm circumference under 12.5 cm)
ranged
from 8% in an established resettlement site to 67% in an
unorganized
camp where only minimal food aid had been given (Tables 2 and 3).
Levels of severe undernutrition (less than 70% of median
weight-for-height or less than 11.1 cm arm circumference) ranged
from
0 to 18% among children in the various sites (1).

Measles had occurred in many sites. At the time of the survey,
immunization campaigns had been conducted in only a few of the
larger
camps. In the rest of the country, vaccination coverage was
estimated
to be less than 5%. Water quality and quantity in most sites were
poor. Diarrhea was prevalent. Little malaria-like disease was
reported. In one area where mortality had been determined by
another
voluntary agency, the rate was at least three times the normal
level
of 20 deaths per 1,000 population per year.

In addition to anthropometric studies, MSF conducted
nutritional
status assessments in 45 areas that had an estimated population of
300,000. This assessment was based on socioeconomic factors,
including migration, family composition, and food supplies and on
whether traditional famine foods, such as leaves and roots, were
being
consumed. The results correlated with nutritional data that MSF
collected later in several of the areas. The MSF studies indicated
that less than 3% of the population lived in areas with adequate
food
reserves, 45% lived in areas with a potential for deterioration
over
the next few months, and 53% lived in areas with serious current
nutritional problems.
Reported by the Government of Chad; US Agency for International
Development, Ndjamena, Chad; Medecins Sans Frontieres, Chad; Africa
Bureau/Regional Affairs, Africa Bureau/Technical Resources/Health
and
Nutrition, Office of Foreign Disaster Assistance, Agency for
International Development, Washington, DC; Div of Field Svcs,
Epidemiology Program Office, Div of Nutrition, Center for Health
Promotion and Education, International Health Program Office, CDC.

Editorial Note

Editorial Note: The major health problem observed was the poor
nutritional status of the Chadian population. The levels of
malnutrition were as high as or higher than those seen in the Sahel
during the 1969-1974 drought (2,3). It appeared that if the food
assistance were not increased, widespread mortality could result.
Based on MSF observations of areas in need, the CDC team estimated
that the minimum aid needed per month was 17,000 tons of food; this
amount considerably exceeded the existing delivery capacity of
10,000
tons per month and was more than double the amount then being
provided.

Efforts were successful in increasing the delivery of food
through
ports in Nigeria and Cameroon and in augmenting the distribution
capacity within Chad. New food-for-work settlement projects were
temporarily suspended until the already displaced population could
be
partially rehabilitated nutritionally. Supplementary feeding
programs
run by voluntary agencies were expanded.

Measles is a serious threat to malnourished populations; low
vaccination coverage levels among children in the displaced
population
constitute a major risk. Efforts were undertaken to increase
vaccination coverage of this highly vulnerable population, such as
mass immunizations in several of the larger camps.

Recommendations were presented to improve the water situation
by
using simple technology to build shallow wells in areas with
superficial water tables. Oral rehydration was well accepted by
the
local population, where introduced, and attempts were made to
augment
local supplies and use.

Malaria did not appear to be a problem at the time of the
assessment; however, many areas of the country are malarious at
least
seasonally. With the beginning of the rains this year, the disease
may pose a significant threat to those whose immunity has waned
during
the drought and to those who have migrated from nonmalarious areas.
Adequate supplies of chloroquine are available in the country.

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